Managing common neurological complications following cardiac surgery

Neurological complications, including postoperative delirium and postoperative cognitive dysfunction (POCD), occur frequently after cardiac surgery. The aim of this article is to enable nurses to consider their role in managing patients who have, or are at risk of developing, neurological complications after cardiac surgery. This article provides an overview of the most common postoperative neurological complications: delirium and POCD

Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool

Objective: To develop and validate a new risk tool (Barts Surgical Infection Risk (B-SIR)) to predict surgical site infection (SSI) risk after all types of adult cardiac surgery, and compare its predictive ability against existing (but procedure specific) tools: Brompton-Harefield Infection Score (BHIS), Australian Clinical Risk Index (ACRI), National Nosocomial Infection Surveillance (NNIS). Design: Single-centre retrospective analysis of prospectively collected data. Patients and Setting: Data from 2,449 patients undergoing cardiac surgery between January 2016 and December 2017 from one European tertiary centre were included. Methods: Thirty-four variables associated with SSI risk after cardiac surgery, identified from the literature, were collated from three local databases. Independent predictors were identified using stepwise multivariate logistic regression. Bootstrap resampling was conducted to validate the model. Hosmer-Lemeshow goodness of fit test was performed to assess calibration of scores. A p-value of <0.05 was considered statistically significant for all analyses. Results: The B-SIR model was constructed from six independent predictors (female gender, body mass index (BMI) >35, diabetes, left ventricular ejection fraction (LVEF) <45%, peripheral vascular disease (PVD) and operation type, and the risk estimates were derived. The Receiver Operating Characteristics curve for B-SIR was 0.679, vs 0.603 for BHIS, 0.618 for ACRI and 0.482 for the NNIS tool. Conclusion: B-SIR provides greater predictive power of SSI risk after cardiac surgery compared with existing tools in our population. Further studies are needed to validate B-SIR on other cardiac populations and specific cardiac patient groups

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Deep Neural Network for Diagnosis of Bone Metastasis

The presence of bone metastasis represents an advanced stage of malignancy with a median survival of a few months and with limited appropriate therapies. The consequent structural bone destruction leads to considerable morbidity, including untreatable pain, fractures, functional impairment which impact on the patient\u27s quality of life. Hence, it is important to make an early diagnosis of bone metastasis to provide an accurate patient\u27s treatment plan to improve overall survival rates and/or quality of life. The aim of this study is to develop a deep learning model using a convolutional neural network to assess the presence of bone metastasis from bone scintigram dataset of a local medical institution. The creation of the network architecture was made using an exploratory process combined with bibliographic search. Several experiments were made to determine optimum combination of parameters (input pixel size, dropout rates, batch size, and number of dense nodes). The model was also compared to the pre-trained architecture used in medical image classification reported in the literature: (1) VGG16, (2) ResNet50, (3) DenseNet121, and (4) InceptionV3. Results showed our base CNN model with good metric performance of 83.97% accuracy, 75.55% precision, 70.83% recall, 73.11% F1 score, and 89.81 % specificity. Our base CNN model outperformed VGG16, InceptionV3 and ResNet50. DenseNet121 showed the higher accuracy and precision results for this dataset, but our base CNN obtained better recall score. Our study showed promising results which could be integrated in the clinical routine workflow. The study has the potential to enhance cancer metastasis detection and monitoring

A case of multiple endocrine neoplasia IIB in a Filipino

A 28 year old Filipina was diagnosed to have multiple endocrine neoplasia (MEN) type 2b at age 22. At age 3, she had growth at the oral mucosa. Multiple neuromas were removed from the tongue and lips by reconstructive surgery at age 18. After a year, she underwent total thyroidectomy. Histopathology result was medullary thyroid carcinoma (MTC). Calcitonin levels done thereafter were elevated. At age 22, modified radical neck exploration revealed metastatic medullary carcinoma to the lymph nodes. Bilateral adrenalectomy showed pheochromocytoma and medullary hyperplasia. Thereafter, there was no rise in calcitonin levels since post-thyroidectomy values. She is presently doing well on L-thyroxine and cortisone acetate. The rest of the family were screened and found negative for MTC

Comparison of MRI, [18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis—a prospective multicenter study

Purpose: Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods: Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results: Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P &lt; 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion: [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study

Current worldwide nuclear cardiology practices andradiationexposure: results from the 65 country IAEA nuclear cardiology protocols cross-sectional study (INCAPS)

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiationoptimizing 'best practices' worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March-April 2013. Eight 'best practices' relating to radiation exposurewere identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more 'best practices' had lower EDs Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally